Provider Demographics
NPI:1821255654
Name:MOSMAN, KRISTIN MEMMOTT (MS, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MEMMOTT
Last Name:MOSMAN
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MEMMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP-CCC
Mailing Address - Street 1:5279 GRAVENSTEIN PARK
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist